Balanced Turbo Field-Echo Sequence for MRI of Parotid Gland Diseases

Ultrasonographic Localization of Parotid Gland Tumor Relative to the Facial Nerve Using Stensen's Duct Criterion

PURPOSE

During the preoperative evaluation of parotid gland tumors, 1 of the main concerns is to determine the location of the tumors in relation to the facial nerve. This study aims to assess the value of ultrasound for determination of the location of parotid gland tumors in relation to the facial nerve using Stensen's duct.

METHODS

This is a retrospective cross-sectional study at a single institute. The subjects who underwent preoperative ultrasound and parotidectomy for parotid gland tumors were included. The subjects with incomplete operative records or no reference standard for the location of parotid gland tumor were excluded. The primary predictor was ultrasound tumor location, which was defined as the location of parotid gland tumors determined by preoperative ultrasound as to whether the tumors were superficial or deep to the facial nerve. The operative records were used as the reference standard for the location of parotid gland tumors. The primary outcome was diagnostic performances of preoperative ultrasound in predicting the location of parotid gland tumors, which were calculated by comparing ultrasound tumor location to the reference standard. Covariates were sex, age, type of surgery, tumor size, and tumor histology. Data analysis involved descriptive and analytic statistics; P < .05 was considered significant.

RESULTS

One hundred and two of 140 eligible subjects met inclusion and exclusion criteria. There were 50 male and 52 female, with a mean age of 53.3 years. Ultrasound tumor location was classified as deep in 29 subjects, superficial in 50, and indeterminate in 23. The reference standard was deep in 32 subjects and superficial in 70. Indeterminate ultrasound tumor location results were grouped as either deep or superficial to make every possible cross table in which ultrasound tumor location results were presented as a dichotomy. The mean sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of the ultrasound to predict the deep location of parotid tumors were 87.5, 82.1, 70.2, 93.6, and 83.8%, respectively.

CONCLUSIONS

Stensen's duct on ultrasound can be a useful criterion to determine the location of parotid gland tumor relative to the facial nerve.

High-resolution MRI of the human parotid gland and duct at 7 Tesla

OBJECTIVES

MR techniques have been reported as an alternative to conventional sialography. High-field systems (7 T) provide new contrasts coupled with increased signal-to-noise ratio, and hence higher spatial resolution. To our knowledge, no measurements of the parotid gland at 7 T have been reported. Therefore, our study aimed to optimize sequences for high-field MR imaging of the parotid gland and duct, as well as the facial nerve at 7 T and show the potential of high field imaging.

MATERIALS AND METHODS

A 7 T whole-body scanner was used together with a 10-cm-diameter loop coil. Various GRE (MEDIC, DESS) and TSE (PD/T2, STIR) sequences were optimized and subsequently tested on 4 healthy volunteers and 4 patients. High-resolution images were compared with 1.5 T images both quantitatively (signal-to-noise ratio, contrast-to-noise) and qualitatively (visual rating of 2 independent readers).

RESULTS

The high 0.6 mm isotropic resolution of the 3D DESS sequence was very useful for defining an oblique orientation with most of the duct being in-plane for subsequent imaging. With the MEDIC sequence, very fine branches of the duct were visible; furthermore, MEDIC yielded a very good depiction of lymph nodes. Severe specific absorption rate problems were observed with the STIR sequence at 7 T. Gland tissue in tumor patients can be well characterized with the PD/T2 TSE. Highest contrast-to-noise between duct and gland was achieved with the 7 T DESS. At 1.5 T, only the STIR sequence showed comparable quality to the overall superiority of the 7 T sequences. The facial nerve could only be depicted close to the skull base.

CONCLUSION

MR imaging at 7 T provides excellent image contrast and resolution of the parotid gland and duct. The proposed protocol offers a noninvasive examination within about 30 minutes.

Parallel imaging technique for the external carotid artery and its branches: Comparison of balanced turbo field echo, phase contrast, and time-of-flight sequences

PURPOSE

To evaluate the parallel imaging technique in the external carotid artery and its branches using 3D balanced turbo field echo (3D bTFE), 3D phase-contrast (3D PC), and 3D time-of-flight (3D TOF) MR angiography (MRA) sequences.

MATERIALS AND METHODS

A total of 26 healthy volunteer subjects underwent 3D bTFE, 3D PC, and 3D TOF MRA with the parallel imaging sensitivity encoding (SENSE) technique. The obtained images were read in a blinded fashion by three radiologists. Interreader and intersequence statistical analyses were performed to compare the visibility of the arteries.

RESULTS

Friedman's ranking test demonstrated that there was no significant difference in visibility between any two pairs of sequences for the external carotid artery and its first branches. However, of the three techniques, 3D PC MRA performed the best for the second-order branches (P < 0.01) and for overall visibility of the external carotid artery and its branches (P < 0.01). The 3D bTFE sequence is superior to 3D TOF; however, an effective means of separating arteries from veins and salivary ducts is needed.

CONCLUSION

The combination of parallel imaging and the 3D PC technique is a promising approach for face and neck MRA.